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14605 Glazier Ave. S. Apple Valley MN 55124 | |
| (952) 432-1103 | |
| (952) 891-8678 |
| Full Name | |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 14605 Glazier Ave. S., Apple Valley, Minnesota |
| Authorized Official Name and Position | Timothy James Montgomery (PRESIDENT) |
| Authorized Official Contact | 9524321103 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
14605 Glazier Ave S Apple Valley MN 55124 Ph: (952) 432-1103 | 14605 Glazier Ave. S. Apple Valley MN 55124 Ph: (952) 432-1103 |
| NPI Number | 1043300262 |
|---|---|
| Provider Enumeration Date | 10/16/2006 |
| Last Update Date | 07/08/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043300262 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (* (Not Available)) | Primary |
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